28 CRESCENT DRIVE - BUILDING JACKET �7 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
� ,- Massachusetts State Building Code, 780 CMR SALEM
_s. Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
�4.. Building Permit Number: Dat Applied:
I� Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.la Is this an accepted street?yes_ no Map Number Parcel Number —�'� nt
Cl)
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq n) Frontage(n) W Tt
r-
1.5 Building Setbacks(ft) cn
IF q
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Proyy¢ed n
W tfr
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zane: _ Outside Flood Zone?Check if yesO Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
7 X 2.1 Owner'ofRecortyed Rajuiddin Salem, MA. 01970
CiaLV I/N\ Name(Print) City,State,ZIP
[4p,MSOO 393 Highland ave. 978-893-6671 Ishtar.raji@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORM'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specily:
Brief Description of Proposed Work': I I)StCtjJ,or jrtiy� r)4 't nr r rn 1.xA V13 0 t:'� Pn,,&_e/
U
S tm
SECTION 4: ESTI4 ATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
S.Mechanical (Fire $
Suppression) Total All Fees:$
(l/` Check No._Check Amount: Cash Amount:_
6.Total Project Cost: $ J V ❑Paid in Full ❑Outstanding Balance Due:
i66n I i'.im - TOM 1. I
23 - x
7 • _
161 . 00
SECTION 5: CONSTRUCTION SERVICES
5.1 \Coln'stwrucction Supervisor License(CSL) 1_�1
) Ck 1 kc� Sryi(rri&n License Numb Expiration atep
Name of CSL Holder
t a 1--, _ ,\I(� CL^ List CSL Type(see below) U
No.and Street 1 ,C/ Type Description
xh , r A rn� �\%ftU� U Unrestricted(Buildings u to 35,000 cu.ft.).mot A/�✓ "I R Restricted 1&2 FamilyDwellin
City/fowq Slate,ZI M Meson
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
7�I�OJ MaSUP.��@U�VI' fl�tt�tY' I Insulation
'I'ele hone Email address D Demolition
5.2 Registered
Home Improvement Contractor(HIC) \,��� r _ ,,
V CoV `1 `t a� HIC Registration Number Expiration Orate
HIC otpO�gy N r,.j-IIC.Regis n[Name
No.an �'treet�•JJ I\ •U�(-, aA y y K as x, Email address
City/Town,State,ZIP t Telephoneneur'
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........❑ No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize V iyyn t SD\CI.I/
to act on my behalf, in natters rel ivy to work authorized by this building permit application.
01/02/15
Print Owner's Name(EfeLLWK ignalure) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
fir A ._, _ 1 (21K-
Print Owner's or Authorized AgenPk)W tie(Ele$Wnic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.ttov/oca/oca Information on the Construction Supervisor License can be found at ww-w.maSs.gov/dps
2. When substantial work is planned,provide the information below:
Total Floor area(sq.ft.) .(including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cosf'
i
Vivint Solar - PV Solar Rooftop System Permit Submittal
1. Project Information
Project Name: CALVIN HAMSON
Project Address: 28 CRESCENT DR,SALEM MA
A.System Description:
The array consists of a 4.59 kW DC roof-mounted Photovoltaic power system operating in parallel with the utility grid.There are(18)
255-watt modules and(18)215-watt micro-inverters,mounted on the back of each PV module.The array includes(2)PV circuit(s).The
array is mounted to the roof using the engineered racking solution from Ecobbrium Solar.
B.Site Design Temperature: (From Boston Logan INT'L ARPT weather station)
Average low temperature: -21.1 °C - (-5.98°F)
Average high temperature: 38.4°C (101.12°F)
C.Minimum Design Loads:
Ground Snow Load: 40 psf (State Board BR&S)
Design Wind Speed: 100 mph (State Board BR&S)
2.Structural Review of PV Array Mounting System:
A.System Description:
1.Roof type: EcoX Comp.Shingle
2.Method and type of weatherproofing roof penetrations: Flashing
B. Mounting System Information:
1.Mounting system is an engineered product designed to mount PV modules
2.For manufactured mounting systems,following information applies:
a.Mounting System Manufacturer: ECollbrlum Solar
b.Product Name: ECorall
c.Total Weight of PV Modules and mounting hardware: 846 Ibs
d.Total number of attachment points: 69
e.Weight per attachment point: 12.26 Ibs
f Maximum spacing between attachment points: *See attached engineering calcs
g.Total surface area of PV array: 316.98 square feet
h.Array pounds per square foot: 2.66 Ibs/square foot
i.Distributed weight of PV array on roof sections:
-Roof section 1: (18)modules,(69)attachments 12.26 pounds
vivint. scaiar
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3. Electrical Components:
A. Module (UL 1703 Listed) Qty
Trina TSM 255-PA05.18 18 modules
Module Specs
Pmax-nominal maximum power at STC - 255 watts
Vmp-rated voltage at maximum power - 30.5 volts
Voc-rated open-circuit voltage - 37.7 volts
Imp-rated current at maximum power - 8.36 amps
Ise-rate short circuit current - 8.92 amps
B. Inverter (UL 1741 listed) Qty
Enphase M215-60-21-1--S22 18 inverters
Inverter Specs
1. Input Data (DC in)
Recommended input power(DC) - 260 watts
Max.input DC Voltage - 45 volts
Peak power tracking voltage - 22V-36V
Min./Max, start voltage - 22V/45V
Max.DC short circuit current - 15 amps
Max.input current - 10.5 amps
2.Output Data (AC Out)
Max.output power - 215 watts
Nominal output current - 0.9 amps
Nominal voltage - 240 volts
Max.units per PV circuit - 17 micro-inverters
Max.OCPD rating - 20 amp circuit breaker
C.System Configuration
Number of PV circuits 2
PV circuit 1 - 10 modules/inverters (15)amp breaker
PV circuit 2 - 8 modules/inverters (15)amp breaker
2011 NEC Article 705.60(B)
vivint. solar
D. Electrical Calculations
1.PV Circuit current
PV circuit nominal current 9 amps
Continuous current adjustment factor 125% 2011 NEC Article 705.60(B)
PV circuit continuous current rating 11.25 amps
2.Overcurrent protection device rating
PV circuit continuous current rating 11.25 amps
Next standard size fuse/breaker to protect conductors 15 amp breaker
Use 15 amp AC rated fuse or breaker
3.Conductor conditions of use adjustment(conductor ampacity derate)
a.Temperature adder
Average high temperature 38.4°C (101.12°F)
Conduit is installed 1"above the roof surface Add 22°C to ambient 2011 NEC Article 705.60(B)
Adjusted maximum ambient temperature 60.4°C (140.72°F)
b.PV Circuit current adjustment for new ambient temperature
Derate factor for 60.4°C (140.72°I) 71% 2011 NEC Article 705.60(B)
Adjusted PV circuit continuous current 15.8 amps
c.PV Circuit current adjustment for conduit fill
Number of current-carrying conductors 6 conductors
Conduit fill derate factor 80% 2011 NEC Article 705.60(B)
Final Adjusted PV circuit continuous current 12.6 amps
Total derated ampacity for PV circuit 12.6 amps
Conductors (tag2 on 1-line)must be rated for a minimum of 12.6 amps
THWN-2 (90°C) #14AWG conductor is rated for 25 amps (Use#14AWG or larger) 2011 NEC Article 705.60(B)
4.Voltage drop(keep below 3%total)
2 art
1.Voltage drop across longest PV circuit micro-inverters(from modules to j-box)
2.Voltage drop across AC conductors(from j-box to point of interconnection)
1.Mirco-inverter voltage drop: 0.19%
The largest number of micro-inverters in a cow in the entire array is 8 inCircuit 2.According to
manufacturer's specifications this equals a voltage drop of 0.19%.
2.AC conductor voltage drop:
=I x R x D C 240 x 100 to convert to percent)
_(Nominal current of largest circuit)x(Resistance of#14AWG copper)x(Total wire run)
_ (Circuit 1 nominal current is 9 amps)x(0.003192)x(140) . (240 volts)x(100) 1.67%
Total system voltage drop: 1.86%
vivin#. solar
EcolibriumSolar
Customer Info
Name:
Email:
Phone:
Project Info
Identifier: 19680
Street Address Line 1: 28 Crescent Dr
Street Address Line 2:
City: Salem
State: MA
Zip: 01970
Country: United States
System Info
Module Manufacturer: Trina Solar
Module Model: TSM-255 PA05.18
Module Quantity: 18
Array Size (DC watts):4.59
Mounting System Manufacturer: Ecolibrium Solar
Mounting System Product: EcoX
Inverter Manufacturer: Enphase Energy
Inverter Model: M215
Project Design Variables
Module Weight: 44.8 Ibs
Module Length: 65.5 in
Module Width: 39.625 in
Basic Wind Speed: 100.0 mph
Ground Snow Load: 40.0 psf
Seismic: 0.0
Exposure Category: B
Importance Factor: II
Exposure on Roof: Partially Exposed
Topographic Factor: 1.0
Wind Directionality Factor: 0.85
Thermal Factor for Snow Load: 1.2
Lag Bolt Design Load- Upward:820 IV
Lag Bolt Design Load - Lateral: 288 Ibf
EcoX Design Load - Downward: 493 Ibf
EcoX Design Load - Upward: 568 Ibf
EcoX Design Load - Downslope: 353 Ibf
EcoX Design Load -Lateral: 233 Ibf
Module Design Moment—Upward: 3655 in-lb
Module Design Moment—Downward: 3655 in-lb
Effective Wind Area: 20 ft2
Min Nominal Framing Depth: 2.5 in
Min Top Chord Specific Gravity: 0.42
EcolibriumSolar
Plane Calculations (ASCE 7-05): 1
Roof Shape: Gable Edge and Corner Dimension: 3.1 ft
Roof Type: Composition Shingle Stagger Attachments: No
Average Roof Height: 20.0 ft Include Snow Guards: No
Least Horizontal Dimension: 31.0 ft
Roof Slope: 20.0 deg
Truss Spacing: 16.0 in
Snow Load Calculations
Description Interior Edge Corner Unit
Flat Roof Snow Load 33.6 33.6 33.6 psf
Slope Factor 0.91 0.91 0.91
Roof Snow Load 30.6 30.6 30.6 psf
Wind Pressure Calculations
Description Interior Edge Corner Unit
Net Design Wind Pressure Uplift -16.0 -26.4 -39.6 psf
Net Design Wind Pressure Downforce 9.4 9.4 9.4 psf
Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0
Design Wind Pressure Uplift -16.0 -26.4 -39.6 psf
Design Wind Pressure Downforce 16.0 16.0 16.0 psf
ASD Load Combinations
Description Interior Edge Corner Unit
Dead Load 2.5 2.5 2.5 psf
Snow Load 30.6 30.6 30.6 psf
Downslope: Load Combination 3 10.7 10.7 10.7 psf
Down: Load Combination 3 29.3 29.3 29.3 psf
Down:Load Combination 5 18.3 18.3 18.3 psf
Down: Load Combination 6a 34.6 34.6 34.6 psf
Up: Load Combination 7 -14.6 -25.0 -38.2 psf
Down Max 34.6 34.6 34.6 psf
Spacing Results(Landscape)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 51.8 51.8 51.8 in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in
Max Cantilever from Attachment to Perimeter of PV Array 17.3 17.3 17.3 in
Spacing Results(Portrait)
Description Interior Edge Corner Unit
Max Allowable Spacing Between Attachments 31.3 31.3 31.3 in
Max Spacing Between Attachments With Rafterf Russ Spacing of 16.0 in 16.0 16.0 16.0 in
Max Cantilever from Attachment to Perimeter of PV Array 10.4 10.4 10.4 in
. . . .
Ski rt
Coupling
0 Clamp Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
0 Bonding Jumper maximum allowable overhang.
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EcolibriurnSolar
Distributed Weight (All Planes)
In Conformance with Solar ABC's Expedited Permit Process for PV System (EPP)
Weight of Modules: 806 Ibs
Weight of Mounting System: 138 Ibs
Total System Weight: 944lbs
Total Array Area: 324 ft2
Distributed Weight: 2.91 psf
Number of Attachments: 69
Weight per Attachment Point: 14 Ibs
Bill Of Materials
Part Name Quantity
ECO-001 101 EcoX Clamp Assembly 69
ECO-001_102 EcoX Coupling Assembly 21
ECO-001_105B EcoX Landscape Skirt Kit 0
ECO-001_105A EcoX Portrait Skirt Kit 5
ECO-001_103 EcoX Composition Attachment Kit 69
ECO-001_116 EcoX Flat-Tile Flashing 0
ECO-001_117 EcoX S-Tile Flashing 0
ECO-001_118 EcoX W-Tile Flashing 0
ECO-001_363 EcoX Lower Support-Tile 0
ECO-001_109 EcoX Electrical Assembly 1
ECO-001_106 EcoX Bonding Jumper Assembly 4
ECO-001_104 EcoX Inverter Bracket Assembly 18
ECO-001 338 EcoX Connector Bracket 18
w rM 4931 North 301 West,Provo,UT 14604 Employer Identification No.: 80-0756438
VIV117t solar
F.
Phone:(8777)4 I29 Fax:(801)765-5758 Massachusetts HIC License No.: 170848
-Mail: suppon@viviDtwiar.com ww I
w.vivintsolarxion AR No.: L 1
RESIDENTIAL POWER PURCHASE AGREEMENT I
This RESIDENTIAL POWER PURCHASE AGREEMENT(This"Agreemem")is entered into by,and between VIVINT SOLAR DEVELOPER,LLC,a I
Delaware limited liability company("We',"Us","Our")and the undersigned Cuslomer(s)("You", Your'),as of the transaction Date set forth below.
Full Name(,_,mi..�q r Full Name Irtrn,mi.za p
CtialOmer(aJ: Pioaerry Owmr D yet 0No _QI1/V I r p/�10p_ �wavy_emaaosar. Df le.,0No
Telephone No.: 0 21-� � �Si W 7 E-Mail: i-� (,Q
Property Street Address K r sC� - �r' -J-
Address: C_ity,County,State,Zip:
—/—_
1.SERVICES I
A. DESIGN AND INSTALLATION. We will design,install,service and maintain a solar photovoltaic system on Your Property,which will include all 1
Solar
panels,inverters,meters,and other components(collectively,the"System") as further described in the Customer Packet and the Work Order that We 1
wJl provide to You hereaMr. All material portions of the System will be installed by Our employed technicians and elecvicians,and not subcontractors. 1
With Your moperetmn, We will p)design, install and connect the System in material compliance with all applicable Taws, (li)complete all required I
inspections;and(iii)obtain all reyuircd certifications and ppecrmits. In order to design a Syystem that meets Your needs,You agree That We may obtain Your I
elecvical usage hatory from Ynur electric utility(the"Ut!/iry')and You shall provide Us with topics of Your Utility bills as We may reasonably request.
I
Other than the activaton fee described in Section I B,We willI ddesign and install the System at st m You.-
B. AC,TI VATION. You agree to pay Us a one-time activation fee in Ihe amount of$ We will interconnect the System with the Utility,sad
cease the System to generate energyy measured in kilowatt hours (kWh"))(the
"Frier nsm lotion of the System generally lakes one day end is
male pted to begin and be sub
Is I complete between two(2)and six(b)weeks here( er.
C. OWNERSHIP OF SYSTEM. We shell own the System as Our sole personalproperty. You will have no property interest in the System.
D. OPERATIONS AND MAINTENANCE. We will operate and maintain the System(i)at Our sole cost and expense;(ii)in good condition;and(iii)in
material compliance with all applicable laws and permits and the Utility's requirements. - - - ----
E. INSURANCE. We carry commercial general liability insurance,workers'compensation insurance,and properlyy insurance on the System.,t For more
mfommlion concerning Our insurance,and to obtain a copy of Our certificate of insurance,please visit: www.vivmtsolar.convinsumrsec.
2.TERM.PRICE.PAYMENT'S,AND FINANCIAL DISCLOSURES
A. ENERGY PRICE. For all Energy produced by the System,You shall pad Us$0. per kWh((the"Energy Nice"),plus applicable razes.
The Energy Price shall increase each year by two and mite-tenths percent(2.9/). A goo an estimate of the System outpue,measured m minable
hours,
will be rovided to You in the Customer Packet. THIS AGREEMENT IS F'OR I HE SALE OF ENERGY BY US TO YOU AND NOT FOR THE SALE OF
A SOLAR ENERGY DEVICE.
B. TERM. This Agreement shall be eflcvaive its of the Transaction Dale and continue until the twentieth(20'")anniversary of the In-Service Date(the
"Term'). The"InServfce Dare'shall be the first day afar all of the following have been achieved: (iJ the System fias been installed and is capable of
gcncreting Energy,{ii)all permits necessary m operate the System have been obtained,(iii)the System has been interconnected with the Utility,and(iv)all
mspecuons and certificates requved under applicable law or by the Utility have been completed or received.
C. PAYMENTS.•Beginning with the first month following the In-Service Date and throughout the Tum;We will send You an invoice reflecting Ihe-
charges far Energy produced bBy the System in Ilia previous month. You shall make monthly payments to Us by automatic ppayyment deduction from four'
designated chtt:kmg account or credit card. It is Your responsibility to ensure that there ere adequate funds or adequate creAlflimiI.There is no financin
emy-Five g
charge associated with this Agreement. Fur all payments more than ten(10)dsys past due,We may Impose a late charge equal to 1'w Dollars($25)
aril interest at an annual rate of ten percent(I /o) plus applicable razes. If You continue m fail to make any payment wlthm ten Om days after We give
You written notice,then We may exercise all remedies evadable to Us pursuant to Sect on 13fb).
D. RENEWAL. At the end of tfie Term,You may elect to(i)continue with this Agreement on a year-to-year basis;(ii)enter-into a new Agreement with
Us and cancel this Agreement;(iii)purchase the System at the-end of the Term ail cancel this Agreement_(the"Purchase Oprfon");or(IV)cancel this
Agrcamera and have the System removed at nu wst m You. Ynu will need to notify Us in writing concerning Your election sizty(60)days poor to the end
of the Term. If You elect the Purchase Option,the"Purchase Oprlon Prfee"will be the then-current Fair market value of the System based on an
mdependenl epyraiser's valuation of similarly sized pholovalmic systems m Your geographic region. The ap miser,'s valuation will be provided to You in
wnnng and well be binding. If We receive Your payment of the Purchase Option Price,costs of the appraiseP applicable taxes,end all other amounts Then
owing end unpaid hereunder,We wdl vansfer ownerstup of the System to You at the end of the Term on an"As Is,Where Is"basis. If You elect to have the
System removed,We will remove the System tram Yuur Proppertrtyy within ninety(9011 dayys attar the end of Ihe Tcrm. IF'YOU DU NUT NU'1'IF'Y US OF'
YOUR F.LF.CTION TO CANCEL BY SENDING A WRI'FI'EN NOTICE TO US,THEN 'PHIS AGREEMENT WILL AUTOMATICALLY
RENEW ON A YEAR-TO-YEAR BASIS UNTIL YOU NOTIFY US IN WRITING OF'YOUR ELECTION TO CANCEL AT LEAST'SIXTY(60)
DAYS PRIOR TO THE END OF 7'HE RENEWAL TERM.
E. CREDIT CHECK. In connection with the execution of this Agreement and at any time during the Term,You hereby authorize Us to(i)obtain Your
credit rating and repon from credit reporting aggencies;(Li)to report Your payment performance under this Agreement to credit reporting agencies;and
(iii)disclose this and other information to Our at Matesand actual or prospective lenders,financing parties,investors,insurers,and acquirers.
WE MAY HAVE PRESCREENED YOUR CREDIT. PRESCREENING OF CREDIT DOES NOT-IMPACT YOUR
CREDIT SCORE. -YOU CAN CHOOSE TO STOP RECEIVING"PRESCREENED"OFFERS OF CREDIT FROM
US AND OTHER COMPANIES BY CALLING TOLL-FREE (888) 567-8688. SEE PRESCREEN & OPT-OUT
NOTICE(SECTION 29)BELOW FOR MORE INFORMATION ABOUT PRESCREENED OFFERS.
1.LIMITED WARRANTY
A. (LIMITED INSTALLATION WARRANTY. We provide a workmanship warranty that the System shall be free from material defects in design and
workmanship under normal operating conditions for the Term. We funber warrant thtt alf rooftop.perichations We install shall be watertiglit as ofthe date of
iinstallaoon. We do not provide any warranty to You with respect to any component of the Syystem. Any manufacturer's warranty is in addition lo,not inlieu
of,this limited installation warranty. This warranty does not cover problems resulting hom exposure to harmful materials and chemicals, fire, flood,
earthquake,or other acts of god,vandalism,allennion of system by anyone not authorized by Us,or any other cause beyond Our control.
B. MANUFACTURERS'WARRANTIES. The System's solar modules carry a minimum manufacturer's warranty of twenty(20 years as follows:
((a))during the first ten(10)ppears of use,the modules'electrical output will not degrade by more than ten percent(10%)from the or gal rated out and
(b)dun the first twenty(20)years of use,the modules'electrical output will not degrade by more than twenty percent(20%)hum Ihe originally rated
outptit. The System'S inverters carry a minimum manufacturer's warranty often(10)years against defects or component breakdowns. During the Term,We
will enforce these warranties to the fullest extent possible.
C. DISCLAIMER OF WARRANTY. EXCEPT AS SET FORTH IN THIS SECTION 3,WE MAKE NO OTHER WARRANIY TO
YOU OR ANY OTHER PERSON, WHETHER EXPRESS, IMPLIED OR Sl' 1� Y, AS TO THE MERCHANTABILITY OR
FITNESS FOR ANY PURPOSE OF THE EQUIPMENT, INSTALLATION, DESIGN, OPERATION, OR MAINTENANCE OF THE
SYSTEM, THE PRODUCTION OR DELIVERY OF ENERGY, OR ANY OTHER ASSOCIATED SERVICE OR MATTER
HEREUNDER, ALL OF WHICH WE HEREBY EXPRESSLY DISCLAIM. OUR LIABILITY FOR ANY BREACH OF ANY
WARRANTY IS LIMITED TO REPAIRING THE SYSTEM OR YOUR PROPERTY TO THE EXTENT REpUIRED TINDER THIS
AGREEMENT'. YOU ACKNOWLEDGE THAT WE ARE RELYING ON THIS_SECTION 3.C.AS A CONDITION AND MATERIAL
INDUCEMENT TO ENTER INTO THIS AGREEMENT. THERE ARE NO WARRANTIES WHICH EXTEND BEYOND THE
DESCRIPTION OF THE FACE HEREOF,
4.REMOVAL OF THE SYSTEM
YOU sh II i I make auv Almmnon (as defined uI Sntioll 4 e 1 0.Ili .s ......911 You n;mt UI task.r p sirs r impn nrtnf.iii 1"tar I ri p n)Ihnr r qutrey
IliiripsaOreran'�l of the SvgnI-rThal mull uuerlcrc wit I i prtnitnit... prI rI.You must ,ie U..:tI I Ihe t)I70)AI\' Irlr wr'uui uolu•
la Cow ni•r-hegm zed 4lwldnvi.) Young",that am repair I.r u ipr i ntcni to You,I ripen)shaff on materialli 'liter Your n. I i0 re the System is
in I dl d \s t: o�+ msau lan rOur renmsal aura and r msLJini m of Ili c}} 1 m 1 u Ieree I.pa it Us a fey (uJ w Pour Hundrcd.md Mittel,-Nine
tg911 is(S44Y�h.hit.R.runny.the Syslent You shall h:irquuod to p:y Ihe Shuulown Payne a k"d.fm.J in Section 15)it the Svs¢m is not runsmll.d
within Ihin) jO)days of r...... . bi the event of an emergency allttling Iho S).vlcni. Yinl shall conmm I!s ilivuclltmdy- II'\Vc;tie unable ur timely
rrsry-rid.Ynu nm Yo y Iat ur...... expense)conrrtwt with a IicenseJ nnJ qun1hwc1 senormm installer remove m e the Syste as n ccss:iry to nwkc repair:required by
the emergency. Ymt shall he rcspunsihie Inr airy damage to the System Ih:u re.ulis lroin aeliuns taken by four amirrvior.
5.ARBITRATION OF DISPUTES
Most customer concerns can be resolved quick)y and amicably by calling Our customer service department at(877)4044129. If Our
'customer service department is unable to resolve Your concern,You and We a�ee to resolve any Disyute(as defined below)through binding
arbitration or small claims court instead of courts of ggeneral 'urisdiaion, BY SIGNING BELOW,YOU ACKNOWLEDGE AND AGREE
THAT W YOU ARE HEREBY WAIVING THE RIGHT T�A TRIAL BY JURY;AND(Il)YOU MAY BRING CLAIMS AGAINST US
ONLY N YOUR INDIVIDUAL CAPACITY,AND NOT ASA PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS OR
'REPRESENTATIVE PROCEEDING. You and We agree to arbitrate all disputes,claims and controversies arising out of or relating to
OF OUR AFFILIATES, DIRECTORS. EMPLOYEES, AGENTS,
OR CONTRACTORS FOR ANY SPECIAL. EXEMPLARY. _
INDIRECT, INCIDENTAL CONSEQUENTIAL OR PUNITIVE
DAMAGFS(WHETHER OR NOf' THE CLAIM THEREFORE IS
BASED ON CONTRACT,TORT, DUTY IMPOSED BY L.AW OR
OTHERWISE).IN CONNECTION WITII,ARISING OUf OF,OR
IN ANY WAY RELATED TO THE. TRANSAC"PIONS
CONTEMPLATED BY THIS AGREFMFNT OR ANY ACT OR
OMISSION Olt EVENT OCCURRING IN CONNECTION
THEREWHIL YOU HEREBY WAIVE,RELEASE,AND AGREE
NOT TO SUE UPON ANY SUCH CLAIM FOR .ANY SUCH
DAMAGES, WHETHER OR NOT ACCRUED AND WHETHER
OR NOT KNOWN OR SUSPECTED T'D EXIST IN YOUR
O FAVOR YOU FURTHER AGREE THAT NCLAIM.
LAWSUIT, OR ANY OTHER LEGAL OR ARBITRATION
PROCEEDING IN CONNECTION WITII,ARISING OIJT OF.OR
IN ANY WAY RELATED TO THIS AGREEMENT MAY BC'
BROUGHT, COMMENCED OR FiLLD MORE THAN ONE (1)
YEAR AFTER THE INCIDENT'GIVING RISE TO SUCH CLAIM. -
YOU ACKNOWLEDGE THAT WE ARE RELYING ON THIS
SECTION 17 AS A CONDITION AND MATFRIAI.
INDUCEMENT TO ENTER INTO THIS AGREEMENT. "
18ANDEMNIFICATION. To the fullest extent permitted by "
applicable law. You hereby agree to indenmi%. advance expenses. '( I ,I i log I,i• i
and hold harmless Lis and Clur aJTiliates, direct6h,a employyees,
aggents, contractors, and Our successors told assigns (eacp, a
"('ovemd Penn.") from any and all third party claims, actions, 1 . 1•1 to I. I t .
costs, expenses(includingg reasonable a¢orneys tees anJ expenses),
damages, Imhdihes,Irenalties, losses,ohligmlons, injuries, demands
and hens of any kim or nature in cnnnectmn with,ansing out of,or
in any way related to(i I Your breach of this Agreement,or(if)Your
ne66lieence or willful misconduct: provided that Your 29.PRESCREF.N AND OPT-OUT NOTICE. THIS
imlciimificntion obligations under this Section IN shall not apply if 'PRESCREENED"'OFFER OF-CREDIT—IS_ RASED ON
the harm or damage that is the basis lui sucF third pattyy claim INFORMATION IN YOUR CREDIT' REPORT INDICATING
occurred while one of Our employyees or agents was 5t Your Property THAT YOU MEET CERTAIN CRITERIA. THIS OFFER IS NOT
nnJ such harm or damagge was sulily caused by the naive negligence GUARANTEED IF YOU DO NOT MEET OUR CRITERIA. IF
or willful misconduct o(such employee or agent. YOU DO NOT WANT TO RECEIVE PRESCREENED OFFERS
19.SlIBROGATION. You abnec w rcclense all Covered Persons OF CREDIT FROM US AND OTHER COMPANIES,CALL THE
from any claims ol'any pnrtics suing through Your authority or in CONSUMER REPORTING AGENCIES TOLL-FREE, (888) 567-
Your name, such as Yonr insurance coinpany, and You aggee to 8688;OR WRITE: EXPERIAN OPT OUT,P.O.BOX 919 ALLEN,
Aefend Us a ninst anyy such claim. YOU AGREE TO NOTIFY TX 75013: TRANSLINION NAME REMOVAL OPTION, P.O.
YOUR INSURANCE<:OMPANY OF THIS RELEASE. BOX 505 WOODLYN, PA 19094: EppUIFAX OPTIONS, P.O.
S0.AMENDMENTS nND WAI\'F.R.S 'Ibis Aenemcnt may only be mnenOzd of BOX 7401'!J ATLANTA.GA 30374-0123.
kohl HA 111 I'll n}y
lit any,peer of the relationship henvicen Ynu:md lJs,whether based in contract.Ion,steu,le or any other Icgal th v+rv;60 this Agreauau or
nny other ngrcancN cuncvrnmg the subject ntnuer hereof: liu) any breach. delnult, nr termin:uwn ul this aercentcnl: and tivl the
li imcrprcnunnt,rnlidiq'.ur entbrceand,ty ul'Ihis Agn;nnenh incluJin•the Jelenninadon of the scope or applied+ility of this Section i leach.n
"Diqurte 1. Prior to commencing arbitration.a ruty nws lirsl senr�a vritlen"Notice of Dis)nne"via cenilial mad to the ulhc, tan))t 'The.
Notice of Dlspule inusl Jescribc the n;norr;uul�asis lirr dtc Uispulc and the rcLcl'sought. II You anJ We�re unable[I,resnite I�m I)ispum
a ilhin Ihinv (:UI Jays, then either p;mv inav comntcnce arbmntien, l'hc 'trhiu'atinn shall be ndministcrcJ I+v .IAh1S purstianl w ns
Sncnmlintt(Arbiirnuon Rulrs:uul Ih'unz(ures(ucuifublr m: It�p:Uwea jmnsadr.avn/rules-su'c:unlin vl-arbitration.the"JAMS Nuled'I and
mtdrr the rules set I'nnh in this Agrcemcul. l'he arhiu'an,r shsll tic hound by the Icrms of lltis Agmentenl. Nn minter the circumstances,dlc
arhnral,r sh,Jl not nerd punitn -p cial,esunpl vv. inJv t or conscycenual dantag s n other p:niv II \ u iaillate arbitrmunt. Yet,
sh Jl be r .punvLl 1< puv S'_.D. All .nturn ,: Ic. . m9vJ cpcn •s, uul rnher cost, 1 the .0 hmm�,.n 'h JI h houn• by You and U,in
n�wr'I m .wvth Ih JANS Rule,auJ ahplicahl Iaa 1 he n III n,shall be CO ductcd I a nwafalle It,c-tblc t dti1 near four Pi perry.
inegnnnt ou an arhitrau nt mvnul It ay n•entered m env cuurl of ctnnpeocnt p,r,sd,cuou. Nothing m-Ihis?cigon 5,hull preclude You or We
iiun seeking pro%isiunal renic I'. in aid ufadntrution 11'ont it coon el cong1CM11 pmsdictian.
NOTICE:BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTE ARISING OUT OF THE
MATTERS INCLUDED IN THE"ARBITRATION OF DISPUTES'PROVISION DECIDED BY NEUTRAL ARBITRATION AS
PROVIDED BY APPLICABLE LAW AND YOU ARE GIVING UP ANY RIGHTS YOU MIGHT POSSESS TO HAVE THE
DISPUTE LITIGATED IN A COURT OR JURY TRIAL. BY INITIALING IN THE SPACE BELOW YOU ARE GIVING UP
YOUR JUDICIAL RIGHTS TO DISCOVERY AND APPEAL. IF YOU REFUSE TO SUBMIT TO ARBITRATION AFTER
AGREEING TO THIS PROVISION, YOU MAY BE COMPELLED TO ARBITRATE. YOUR AGREEMENT TO THIS
ARBITRATION PROVISION IS VOLUNTARY. YOU HAVE READ AND UNDERSTAND THE FOREGOING AND AGREE TO
,I SUBMIT DISPUTES ARISING OUT OF THE MATTERS INCLUDED IN THE "ARBITRATION OF DISPUTES"PROVISION
+� TO NEUTRAL ARBITRATION. cw"q. Inn,�a:
UWF.AGREE TO ARBITRATION AND WAIVE THE RIGHT TO A JURY TRIAL; (Ir//-rJ/4Jr/lVr II�JII
6.NOTICE TO CUSTOMERS
A. LIST OF DOCUMENTS TO BE INCORPORATED INTO THE CONTRACT: (i)this Agreement,(it)the Additional Terms and
Conditions,(iii)the Customer Packet,and(iv)the Work Order. These documents are expressly incorporated into this Agreement and apply
to the relations(hrip between You and Us.
B. IT IS NOT LEGAL FOR US TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE
TO REMOVE GOODS INSTALLED UNDER THIS AGREEMENT.
C. DO NOT SIGN THIS AGREEMENT BEFORE YOU HAVE READ ALL OF ITS PAGES. You acknowledge that You have read
and received a legible copy of this Agreement,that We have signed the Agreement,and that You have read and received a legible copy of
every document that We have signed dining the negotiation.
D. DO NOT SIGN THIS AGREEMENT IF THIS AGREEMENT CONTAINS ANY BLANK SPACES. You are entitled to a
(completely filled in copy of this Agreement,signed by both You and Upps,before any work may be started.
E. YOU
Y CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO THE LATER OF:
DNIGHT OF THE
THE NOTICE OF CANCELLATION BESS DAY AFTER THE ELOW FOR NSACTION DATE,OR(TITH START TH S RIGHT,INSTALL AT OIN OF THE SYSTEM. SEE
VIVINT SOLAR DEYF; c
, CUSTOMER(S): (3�-y /y�
By . . By. _ ,��
Printed Name: LOV L Printed Name:e- f9' �AN y'
Title: - Aw By:
Printed Name:
'transaction Date:
FOR INFORMATION ABOUT CONTRACTOR REGISTRATION REQUIREMENTS, CONTACT THE MA SACHUSETTS
OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION: TEN PARK PLAZA,SUITE 5170,BOSTON,MA 02116,
(617)973-8700 OR 898-283-3757.
-----_-----------------------------_---------—-----------_________________-________________________-_
NOTICE OF CANCELLATION
Transaction Date: AR No.:
YOU MAY CANCEI.THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE (3)BUSINESS
DAYS OF THE ABOVE DATE, OR (IF LATER) UNTIL THE START OF INSTALLATION.OP THE SYSTEM. 5IF YOU
CANCEL,ANY PROPERTY TRADED IN ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY
NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS
FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST
ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO
THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS
DELIVERED TO YOU UNDER THIS CONTRACT OR SALE, OR YOU MAY, IF YOU WISH, COMPLY WITH THE
INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE
AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP
WITHIN TWENTY(20 DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE
OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE
SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN
LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,
MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN
NOTICE,OR SEND A TELEGRAM TO VIVINT SOLI DEVELOPER LLC,AT 4931 N 300 W,PROVO,UT 84604 PRIOR TO
THE LATER OF: (1)MIDNIGHT OF THE THIRD(3 BUSINESS DAY AFTER THE TRANSACTION DATE,OR(11)THE
START OF INSTALLATION OF THE SYSTEM. I HEREBY CANCEI.THIS TRANSACTION:
Date: Customer's Signature:
I
i
� nu..n: .., n. ,, n,.. ... illfliµld RcvreO Hucv in eeiu R•n re'n.
ADDITIONAL TER MS AND CONDITIONS
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THISItSTIA1 FOR A N\ P C R IOO OE ANY COS I SAVIN(S We are IIIwihty II I,IHII qVl 1 In II a I1 II ,
rt,ase a yallhrl nN obligations l ilfyornon. i'..In 1 u 'I'll,l II In
err- c gcoto ppoi YIw un I m r' We ale 111s tat I'L, ela I.. 1 n1 I I \I ( a
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any nv 1 , l 1 : 1 f J.
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a1�Ill na o toldhcnl w.hn lM1csold),rspl liheroodbun such uLnryk Ih• ,.+1 1 Is li-(111 1 1 1 d: n
01 I or V<ur told. csau of due II rc-ITht Loch pWIN could not 'a In,hly hale been xpmrM to avoid,
11.h�N NERSHIP OF CYS rEM (a)OuI wnershi t I�Ih S ss_1�� We shall nwn and xhlcl by tile er t Cut dihcula such puny xrtimut fault attributableIon s
andh IJall Pr.penrrElt the S)) min al dael) rm ml cnal' Yon inanh o unuhlel 1 m.' tiud'ng but not lmlul W.action by It pournncmol n Ihory,
pmpenl I nsu 1he Sy l n the S>1 1 1 1 .w ex Pr for 11l ll b xr¢\dial The fafl n 1 act n the nan fan, t\cmn nnlal anN ry .IF Ill 1' 1 'd.:flhvl
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°. • 1 i ITT I` I II w.l n JII '' 1 ....... NOTWITHSTANDING ANY BREACH OF THIS AGREEMENT,
an ,An, , p ,I,rn ... I 1[,,, ,, ww 1 I It.
..... Y,r
,a,l,IibnF«,n M1c I,x„nrl,,lad t+11,nrn,,,L,rld or„The y,lcrn dlrlil „111,n.ea,nd ANY FAILURE OF THF. SYSTEM,OR ANY NEGLIGENT ACT
d.wl 'I i.II I 'n\ THAT CAUSED ANY INJURY OR LOSS (WHETHER
12 \SSH'S\II�I k Ilt\♦ yl'H \ a . 1f 11 1 PROPERTY DAMAGE, PERSONAL INJURY OR DEATH) TO 'I III 1 ' 1111, \p tr �'1 I --1 1 ,'.,, ANYONE. WE. AND YOU AGREE THAT, UNLESS SUCH
tnl ' lle nnJy ihnl\crctmam llk+LI��111im,`I'LlarIr.�hah,Invl:��.I+II��nwo a...i, INJURY OR LOSS WAS CAUSED BY A PARTY'S GROSS
It v. 'IT"11 ill -n y I,1,1 ^" r,ll 111 r. 1 ,1I_Jl t(c NEGLIGENCE, FRAUD, OR WILLFUL INJURY, SUCH
4,w ,A I `y m ' °' 1.1. p " "'°`' t PARTY'S LIABILITY ARISING OUT OF OR RELATING TO
.I........
l l I nl hu1 l ,-.. ihn er u., u l u Jull ,IIJ+ Ii, ..ne if""
THIS AGREEMENT , YOU IN NO EVENT EXCEED THE
LlI n,, o, u i I' III. 111 I ,nn 1 :erne DEFAULT PAYMENT. YOU AND WE AGREE THAT THIS
1rm.val nal W'c r,a.LI"I mp \• ,+ 11,,.Iola II:n I•r„y.m 111,11,l 11 AMOUNT IS A FAIR RGPRF.SENTATION OF THE DAMAGES
acre:u1,vluup nnL Ih.ualim Ian.nv'.. tLmlunle1nllr ....l1lbell,b,kundrl
�i'I'i'i'al l•luy.tier.-Iki I��ti.i�ou.ci�illi.iv�d,�,"��i�I�ril lII I L:,"tl ir..n�l, ;:111: THAT YOU OR WE EXPECT TO INJURY OR LOSS HEREUNDER.
IN THE CASE OF ANY
n01 adwpuucly 111&1nonht F,a hR1i ,hbp:Rnv1I under Ihr, apnenxuf, o
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p 1 Ilamirlee niir,<.ur „r m\,nn r�Nly.,,uon,raider 16,, t,ruoman. W. NO CLAIM SHALL BE MADE BY YOU AGAINST US OR ANY
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NEC 690.64(8)(2)(a)? X YES NO do,bulb temperature for ASHRAE bcation most similar to installation location: -19"C
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based on ASHRAE Lion: 39onth 2%dry bolt
temperature for ASHRAE Iowtion most similar to installation location: 39'C O
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AC Qutpul Current 1 16.200000 Amps temperature of 47°C or less(all of United States),
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THIS PANEL FED B ANMULTIPLE SOI-AR SOURCES or less when protected!by a 12-Amp or smaller fuse.
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NOTE: NEUTRAL CONDUCTOR(S)OMITTED FOR CLARITY a
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The Commonwealth of Massachusetts
Department of IndustrialAccidems
Office of Investigations
I Congress Street,Suite 100
Boston,MA 02114-2017
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organization/individual): Vivint Solar Developer, LLC
Address:3301 North Thanksgiving Way,Suite 500
City/State/Zip:Lehi, UT 84043 Phone#:801-377-9111
Are you an employer? Check the appropriate box: Type of project(required):
LE I am a employer with 10 4. ❑ I am a general contractor and I
employees(full and/or part-time).' have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. T ❑ Remodeling .
shipand have no employees These sub-contractors have
8. ❑ Demolition
working for me in any capacity. employees and have workers'
comp, insurance.l 9. ❑ Building addition
[No workers' comp. insurance P•
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t ' 13.X Other Solar Installation
employees. [No workers
comp, insurance required.]
"Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit.indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:Zurich American Insurance Company
Policy#or Self-ins. Lic.#:WC 509601300 Expiration Date:11/1/2015
Job Site Address: Q lV� I City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided abov Is true and correct.
Signature: Date II '/
Phone#: 801-2296459
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building(Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
fill
I.
'��® CERTIFICATE OF LIABILITY INSURANCE °;D ;z9N;40"'"Y)
TffIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorseme s).
PRODUCER CONTACT
MARSH USA INC. NAME:
122517TH STREET,SUITE 1300 PHDNE FAX
DENVER,CO 80202-5534 E-MAIL AC No:
Attn:Denver.mrbequmt@mamh.com,Fax:212.948.4381 ADDRESS:
INSURE S AFFORDING COVERAGE NAIC#
462738-STND-GAWUE-14-15 INSURER A:Evanston Insurance Company 35378
INSUREDVvim Solar,Inc: INSURER e:Zurich American insurance Company 16535
Vvint Solar Developer LLC INsuRER C:American Zurich Insurance Company 40142
3301 North Thanksgiving Way INSURER O:
Suite 500
Lehi,UT 84043 INSURER E:
w3URERF:
COVERAGES CERTIFICATE NUMBER: SEA-002368030-08 REVISION NUMBER:0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
hLTTRR TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP
POUCYNUMBER MMIOIONNYVII IMMUDDNYYYI LIMITS
A GENERAL LIABILITY 14PKGWE00274 11/0112014 11/01/2015 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea owunenw $ 50,000
CLAIMS-MADE In OCCUR N ED EXP(Any one person) $ 5,000
X $5,000 Dad.III&PD PERSONAL S ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 2,000,000
POLICY FT PR0. LOC I I $
B AUTOMOBILE L#nuiLry BAP509601500 111012014 11/01/2015 COMBINED SINGLE UMIT 1,000,000
Fa accident)
Ix
ANY AUTO - BODILY INJURY(Per person) $
ALL OWNED SCHEDULED RY AUTOS AUTOS BODILY INJU (Par acdden0 E
HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
AUTOS Peracddent $
$
A UMBRELLA LIAR X OCCUR 14EFXWE00088 111012014 111012015 EACH OCCURRENCE $ 5,000,000
X EXCESS UAS CLAIMS-MADE AGGREGATE $ 5,000,000
1 DIED 771RErENTIONS $
C WORKERS COMPENSATION WC509601300 11/01/2014 11/0112015 X I WC STATU- IOTH-
AND EMPLOYERS'LIABILITYB ANY PROPRIETOWPARTNER/EXECUTIVE YIN WC509601400 11/0112014 11/01/2015 $ 1,000,000
OFFICER/MEMBER EXCLUDED? � NIA E.L.EACH ACCIDENT
(Mandatory In NH) E.L DISEASE-EA EMPLOYE E 1,000,000
If es,describe under
DESCRIPTION OF OPERATIONS below, E.L.DISEASE-POLICY UNIT $ 1,000,000
A EDors&Omissions& 14PKGWED0274 11/012014 11Po1/2015 LIMIT 1,000,000
Contractors Pollution DEDUCTIBLE 5,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Arms ACORD 101,Additional Roma"Schedule,B more spew IS reputed)
The Certificate Holder and others as defined in the written agreement ale included as additional insured where required by written contract with respect to General Liability.This insurance is primary and non-
contributory over any e)dsbng insurance and limited to liability arising out of the operations of the named insured and where requited by written contract Waiver of subrogation is applicable where required by written
contract with respect to General Liability and Workers Compensation.
CERTIFICATE HOLDER CANCELLATION
City of Salem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
93 Washington Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Salem,MA 01970 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATME
of Marsh USA roc.
Kathleen M.Parsloe 'ys,[�vx.Ar. f4,Lalsr;
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
i 1 I IId,:6 .I It1m �!. i.
VJ111GC Ul LUI1JUHIC1 til1A.11J d11U 13USlliGJJ 1<Cg'U1dl.1011
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor registration
Registration: 170848
• Type: Supplement Card
VIVINT SOLAR DEVELOPER LLC. Expiration: 1/512016
JAMES SHERMAN
4931 NORTH 300 WEST
PROVO, UT 84604
Update Address and return card.Mark reason for change.
son 1 Ci ZOM-0511I Address ❑ Renewal ❑ Employment Lost Card
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction -04525
or
License: CS-046254
JAMES R SHER117 O -
6 Fox Hollow Dr14e n �
SAUGUS MA 01506 y l
ti
•� " 't Expiration
Commissioner - 08/28/2016
u i
i, L
y f Mont so I a 1 3301 North'thanksgiving Way,Suite 500
Structural Group Lehi,UT84043
P: (801)234-7050
Scott E. Wyssling, PE
Head of Structural Engineering scott.wysslingCa vivints0lar.com
January 5,2015
Mr. Dan Rock, Project Manager
Vivint Solar
24 Normac Road
Woburn MA 01801
Re: Structural Engineering Services
Harrison Residence
28 Crescent Dr, Salem MA
S-4105123
4.59 System
Dear Mr. Rock:
Pursuant to your request, we have reviewed the following information regarding solar panel installation on
the roof of the above referenced home:
1. Site VisitNerification Form prepared by a Vivint Solar representative identifying specific
site information including size and spacing of rafters for the existing roof structure.
2. Design drawings of the proposed system including a site plan, roof plan and connection
details for the solar panels. This information was prepared by the Design Group and will
be utilized for approval and construction of the proposed system.
3. Photovoltaic Rooftop Solar System Permit Submittal identifying design parameters for the
solar system.
4. Photographs of the interior and exterior of the roof system identifying existing structural
members and their conditions.
Based on the above information we have evaluated the structural capacity of the existing roof system to
support the additional loads imposed by the solar panels and have the following comments related to our
review and evaluation:
Description of Residence:
The existing residence is typical wood framing construction with the roof system consisting of 2x6
dimensional lumber at 16" on center with 1x8 collar ties every 32". The attic space is unfinished and the
photos indicate that there was free access to visually inspect the size and condition of the roof rafters. All
wood material utilized for the roof system is assumed to be Hem-Fir #2 or better with standard
construction components. Our review of the photos of the exterior roof does not indicate any signs of
settlement or misalignment caused by overstressed underlying members.
Stability Evaluation:
A. Wind Uplift Loading
1. Refer to attached Ecolibrium Solar calculations sheet for ASCE/SE17-10 Minimum Design Loads
for Buildings and other Structures, wind speed of 100 mph based on Exposure Category "B" and
20 degree roof slopes on the dwelling areas. Ground snow load is 40 PSF for Exposure"B", Zone
2 per(ASCE/SE17-10).
2. Total area subject to wind uplift is calculated for the Interior, Edge and Corner Zones of the
dwelling.
dodont. solar
Page 2 of 2
J
B. Loading Criteria
10 PSF=Dead Load roofing/framing 40 PSF=Live Load(ground snow load)
5 PSF= Dead Load solar Panels/mounting hardware
Total Dead Load=15 PSF
The above values are within acceptable limits of recognized industry standards for similar structures
and in accordance with the 2012 International Residential Code. Analysis
performed of the existing roof structure utilizing the above loading criteria indicates that the existing
rafters will support the additional panel loading without damage, if installed correctly.
C. Roof Structure Capacity
1. The photographs provided of the attic space and roof rafters show that the framing is in good
condition with no visible signs of damage caused by prior overstressing.
D. Solar Panel Anchorage
1. The solar panels shall be mounted in accordance with the most recent "Ecolibrium Solar
Installation Manual',which can be found on the Ecolibrium Solar website (ecolibriumsolar.com). If
during solar panel installation, the roof framing members appear unstable or deflect non-
uniformly, our office should be notified before proceeding with the installation.
2. The solar panels are 1 Yz'thick and mounted 4 1/2'off the roof for a total height off the existing roof
of 6". At no time will the panels be mounted higher that 6"above the existing plane of the roof.
3. Maximum allowable pullout per lag screw is 235 Ibs/inch of penetration as identified in the
National Design Standards (NDS) of timber construction specifications for Hem-Fir (North
Lumber) assumed. Based on our evaluation, the pullout value, utilizing a penetration depth of 2
Yz', is less than the maximum allowable per connection and therefore is adequate. Based on the
variable factors for the existing roof framing and installation tolerances, using a thread depth of 2
Yz' with a minimum size of 5/16" lag screw per attachment point for panel anchor mounts will be
adequate with a sufficient factor of safety.
4. Considering the roof slopes, the size, spacing, condition of roof, the panel supports shall be
placed at and attached to no greater than every fourth roof rafter as panels are installed
perpendicular across rafters and no greater than the panel length when installed parallel to the
rafters (portrait). No panel supports spacing shall be greater than four (4) rafter spaces or 64"o/c,
whichever is less.
5. Panel supports connections shall be staggered to distribute load to adjacent rafters.
Based on the above evaluation, it is the opinion of this office that with appropriate panel anchors being
utilized the roof system will adequately support the additional loading imposed by the solar panels. This
evaluation is based on information supplied to us at the time of this report and current industry standards and
practices.
Should you have any questions regarding the above or if you require further information do not hesitate to
contact me.
YtN gF�S9
E �
CM
Scott E.Wyssli PE ° 50
MA License No. 505 9o`F8SIOIST
NA P�
bodont. solar
The ('onw,rn°wealth of Ma85AChtlSCllS ! Ia,It CC11
t Board of BILIdding Regulations and Standards Mt'NI('ll'-\I I'I Y
Massachuselts State Building Code. 780 CMR. 7 edition I'Sf
Building Permit Application To Construct. Repair. Renoxule Or Demolish a Rrruw d./,um.,,,
One- or Tuv,-Faenilr Uuadliu,i; k
This Section For Official Use Only
Building Permit Nut Date applied:
Signature::
Building Cotton ssuut r/ Inslxuur of Buildings Date
SECTION I: SITE INFORMATION _.
1.1 Property Address: 1.2 Assessors Mup & Parcel Numbers
Sia Number Para) Mitotic, _--._-_ -
I.la Is this an accepted street! yes— no, p
1,3 Zoning Information: 1.4 Properly Dimensions:
Zoning District . Proposed Use Lot Area(sy lit Frontage J,t)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
t
! Required Provided. Required PnrvideJ Required Pruaided .t
1.6 Water Supply: tM.G.L c. 40. ti 5a) L/ F1ood Zone Information: Lg Sewage Disposal System:
Zone: Outside.Flood Zone? Municipal ❑ On site disposal system ❑ p
Public❑ Private C3 Check if yes❑ _
SECTION 2: PROPERTY OWNERSHIP' j
2.1 Owneri of Record:t'i )
,A cp J g ter tpi Sr
Name(Print) Address For Servtee: '
Signature Telephone t
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑. Repairs(s) ❑ Alterati,:m(s) ❑ Addition ❑
Demolition ❑ Accessory
-Bldg. ❑ Number of Units_ Other JO Specify:_Sy�✓c y
Brief Description of Proposed Work-:
v W
he ri e w �1 04S Wit'M .X It Ci �
° SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
ILahor and Materials) — -
I. Building $ 1. Building Permit Fee: $ Indicate how fee is deter mined: ,
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost) (Item 6) .x multiplier x
4
3. Plumbing S 2. Other Fees: S
J. Mechanical (Hb':1C) $ List:
5. Mechanical (Fire S Total All Fees: S
Su) reseion)
Cheek No. Check .-Amount: Cash Amount:_.
1 b Total Project Cost: $ $. � 3,, c}7 ❑ Paid in Full ❑ Outstanding Balance Due:
i
�r0Chor S �PS ro C
' SECTION 5; CONSTRUCTION SERVICES
t 5.1 Licensed Construction Supervisor(CSL)
L - F' -• S � .. License Number lispu'att.ni Date. '
' Nana of C:S ¢
All/D l''b'j tnal , List CSL'Fcpe Uee helot)
\ddre�. Tv. • Descri roost i
C Unrestricted iu to}5,(A)U Cu. Ft.i i t
R Restricted 1&_2 Faml. Dwelhng
Signature WD
Nia-,onn Only
Rcsidcnhal foaling CLterm
' Tcic hunee - I
� P ItciJi nnul \\1nJuw .mJ SiJuw .
Rcsideuoal Solid Fuel-1$unwe \ t tli.wc_e.hni.dldun❑
Residential Dvintilrtton
5,2 Registered Home =yiment Contrrctor(IIIC)
<�r-)2 < r�7rs cam _ Inc
i I11C Company Nan c or H Registrant Nance YSv Registration Number
z! r°rJ7v _ ~7 y
.
t '� �/'`"�,5 �4f Expiration Date
Signature - Telephone - t
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. S 25C(6))
( Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure w preside
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ........A� No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. as.Owner of the subject property hereby
authorize rxoc)-`7?r. 11 J tS . (C\, )v G to act on my behalf, in all mutters `
relative to work authorized by this building.permit application.
9
o
t
Signature of Owner Date
# SECTION 7b: OWNER' OR AUTHORIZED ACENT DECLARATION
t,X�(. :•441 66 1 `J ,as Owner or Authorized Agent hereby declare
that the statements andinformation on the foregoing application are true and accurate..to the best of my knowledge and �.
I behalf
�• �., rJ fS l P�� {
Print Name
Z -r
Signature giKowner or Authorized Agent Date
9 (Signed dnder the pains and penalties of er'u )
NOTES:
1. An Owner who obtains a building permit to do his/her own work.or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor(HIC) Program), will!L01 have access it) the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
I Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 1 10.R5.-respectively,. l
a
When substantial work is planned, provide the information below:
a Total floors area(Sy. FL1 (including garage. finished basement/attics.decks or porch)
Gross living area iSy. Ft.) Habitable room L:ounr _
( Number of fireplaces Number of bedrooms _r
Number of h;uhruoms Number of half/baths
'type of heating system Number of.decks/punches �,-________
'Type of cooling system Unclosed 'Open
{ 3. 'Total Project Square Footage" may be substituted fir "Total Project Cost"
CITY OF SALEM
a =�
PUBLIC PROPRERTY
DEPARTMENT
�Lv1, uc C: U'.1.It;v,;r,,.Suu.rt • J�l:sl. ALl•..v rr ,tt ;+;19��
frI , 9-8--�;-0;05
Workers' Compensation Insurance At'lidacit: Builders/Contractors/Electricians/Plumbers
l flitant Information (��\t pe Q
( Please Print Leeiblw
Ncllilc113usutc�: Ir�.mie1a t,tn:InJn iJuell: C /'��� •� `— "eS "
Q '
�LWIVSS. t �1 � �� n
City,State;Zip: l�r�Bl �� ��. Ory Phone : / ?525—2 �
Are you an employer? Check the appropriate box: Type of project (required):
1 I an,a employer with FV l--L y. ❑ 1 am a general contractor and 1 6. ❑ New construction
employees (full and/or ).art-time ' have hired the sub-contractors
P listed on the attached sheet. r ❑ Remodeling
?.❑ I All, a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are it corporation and its I B.❑ Electrical repairs or additions
officers have exercised their
l (,❑ Plumbing airs or additions
3 ❑ a h.i I am a homeowner doing all work right of exemption per MGL g repairs
4 and we have no Roof repairs
I I_
myself. No workers' Bump. �❑
Y [
No workers' �r employees. � I
insurance required.] 13.� Other - �•
comp. insurance required.) �k°._ oUSr
•.\ny applicant that checks box ttl meet also tin out ahe section below showing their workers'compensation policy information.
' rots•owners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
nuacrors th:v.heck this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
/urn att employer that is providing workers'cotttpen.sution in.surunce for my employees. Below is the policy and job site .. j
information.
Insurance Company Name: nirneyynA ZVk )C�7W /'
Policy 9 or Self=ins. Lic. ?l: U 5 / 38 —73D Expiration Date: (— I�` v �Y.
�7 QP2!SCP,I,�- �6Z ' �JE�7�
Job Site Address: l i�+ —City/State/Zip: �('0f).
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
i:aihric to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S l joomo wld,'or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of ap to S250,00 a day against the violator. Be advised that a copy of this statement may be f2mvarded to the Office of
Incc,lit;u ions of[Ile DlA for in urulee coccrage verification.
l du herehy rerti/1'm ler th wins and penaties ul'perjury that the infurntution provided above is true and correct.
Date: O
1iCn.nurd: l
Phon '�� S 2nu D -
Official u.ve onlF, Do not write in this area, to be completed by city or town ofjiciaL
CCity or fowrt: _.___._— Permit/License ---
Issuing Authority (circle one):
I. Board of lleallh 2. Building Department 3. City/Town Clerk J. Electrical Inspector 5. Plumbing inspector
6. Other . -- —
Contact Person:-----__--_---- Phone
c
Information and Instructions
\la>.a.:hu se its OCne r.J LaWS chapter I�I rcquiI CS :III employees to pI oc ide workers compensation Ior their em plot ces.
P t I[,I I.InI to III is ,ru tire, an elnplo.ree is JelineJ s even person in the se rc ice ofano Ill er under anv contract of hire.
cyvcss or implied. oral or arisen." -
\n eiuplorer is Jelined as "an indi'k iJual. p.lrmcnhip. assuciarion, corporation or other legal entity. or any tnvo or more
"t the fnrc_oing engaged in ajoint cnlerprise, and including the legal rcprescntati,,cs ofa deceased rinpI(')ver. or the
rccci%er or trustee of an individual, partncr>hip, association or other legal entity, cmploc ins_ employees. I lo%recer the
n•.�ncr of a dwelling house hating not snore titan three apartments and who resides therein, or the occupant of the
Jet cl ling house of another who employs persons to do m-aintenance, construction or repair work on such dwelling house
,11 011 (he ,rounds or huilding appurtenant thereto ;hall not hecause of;uch employ ntent be deemed to be an employer.*'
\IUL chapter 152, i2506) also states [hat 'every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.-
Addirionally, NIGL chapter I i?, § 5(-(7) stares "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable e%idence of compliance with the insurance
I equirements of this chapter have been presented to the contracting authority."
Applicants
Please till out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractors) nante(s), address(es) and phone number(s)along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also he sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line. .
City or Town Officials
Please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of[he affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or
Iown)." \copytif the affidavn that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on tile for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
H.c. a Jog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The t lffice of Investigations would like to [hank you in advance for your cooperation and should you have any questions,
please do nor hesitate to give us a call
I he Dcparnncnt's address, telephone and Iax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Offlce of Investigations
600 Washington Street
Boston, MA 02111
Tel. tl 617-727-4900 ext 406 or 1-877-MASSAFE
ILc�ixcJ �-'b-Ui
Fax # 617-727-7749
www.mass.gov/dia
04715/2008 22:44 FAX 6178876633 , DOR (a001/001
SA� . The �� add
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you may easel this agreement if it Ms ben cams mated by a party dweno at a place offer dun. Pords Fmdomrw GareI
. a address of the seller,which may be his main offce ar bunch thereof,by a written notice dimaed Swimming Pods Carets
to the seffer at his maim or branch oftks by ordinary mil postect by telegram iry darvery not - Whirlpool Baths Dedu
doerthan middglttof be third business day following the signingotjbis agmcmenn, Accessories Spar&Satttta's
SUI.D TO. Calvin and Freda tlamsm -
28 CrescentDdV9 .
JOB NO.
Salem Me 01970
HOMEPHONB 978-T48-21f
JOB ADDRESS:-: Same
-WORKPHONB - ---- _
V Wa,the owner(s)of the premises mentioned above,hereby contract and authorize you to f mnish an necessary metaials and labor,to install.
Construct and place tiro EmptovemMU eocading to tiro following apecifcatimms,tams and.condition,on the premises described above,wbich we
Palm Ind sepesent that we have good legal title tow ownm in our names.
DESCRIPTION OF RdPROVEMIIVTS: Remove and df/spose efexlsdrre/roar areas m stave addrea
and conviruct pressure treated framed woodataps in same size and lay• e -nee areaw w1 ft 514 77mber rech canto
deek129 brstaHed with trapeze WV"and 77mber Tech White corn osHe rap i[iestem Encloste aea its and landlrra with white
vfnyf 18tfk0 tr MM*d KM white halt All AMR dyere fo be white azak .aa..er n or aaaD!o be on r h r jrar Sams
90000y ell labor and nraferfels for above Cn Deden . nre'Is rea Mnalble for sit ctnfr.adit ti g t,h ll7 an rmx
TOTAL CASH PRICE $ 8.000.00
LESS:DOWN PAYMENT $ a.000.00 .
-— - _ -- BALANCE DUE
- iIPONLY7MPI13TION"`�'` -- 3-�0b0.a0
1•r IS MUTUALLY AGREED THAT:
TITLE to said improvements shah remain is the aener until the twat cash price is fully paid by the Buyer(s)and said impmvernents shall continue to
remeiapersomhy notwithstanding the installation of the game in or the annexation of the same to the ptrntiset described
This Agreement shall not be binding upon Seller moil approved by its Credit Department and executed by its Authorized Ageat.
The t a nor and conditions of this Agreement at contained on both aides of this page. l.7 ya Q�
IN VMWESS WHEREOF the parties hereto have caused this agreement to be y ecuv d this ` day of�20 W
LS.
Saltzman Buyer
ACCEPTED ON 20 L.S.
Beyer
CROCKER SALES CO.,INC.
BY
. lets.-seas'phea tngr. - -
BUYER ACKNOWLEDGES RECEIPT OFA COPY OFTHIS AGREEMENT
MY 5"
2'6" �
j o
10"top tread
7"riser 2x12p.t.
stringer �0 _
ste treads 2x6 p.t. dbl rim joist
P
i
will be 5/4 x 6
timbertech
composite decking 4'0"
4x4 p.t./
posts
timbertech S WyLL
o rail system
80
p.t. 2x6 notched in
to 4x6 post
' 4x6 p.t.posts /
4'3 1/2"
5-2x12 p.t. stringers
/ post base \
-------- ------ ---
concrete base pad"-
"
4'x 1'concrete
footings
=�
e y t.j
�F I
K- 1 O„A
s'o° —�
\ —2x8 p.t.ledger board nailed and screwed w/timbertech
ledger screws to the house
doubled 2x8 p.t. rim joists
1'4"-
0
e 2x8 p.t.joists spaced 16"on center
steel joist hangers
location of the posts and footings
- -------------- - -------------- - - --------- --- - - - ---- -
- -------- -- - ----------- --------------- --- --- - -----
-
step treads 7"riser 10"tread
514 x 6"timbertech composite decking will
- --------------- -- --------------- - --------------- -- ---------------- - used on the platform and treads
o i
- ------------ -- ----------------- ------------ ---------------- -
- ------------ -- ---------- - ----------- -------------- -
- ---------------- ------------------ - -------------- ------------------- -
- ------------ -- ----------- - -------------- - ---------------- -
CITY OF SALEM
PUBLIC PROPRERTY
- l
a* DEPARTtiIENT
-
\1'.•...r< L'� `)t'�\1 i[�,{-.UN�:RcET • �.\l. N. 51.E\iN lit .1., .\ ..')''
(FI:V78-74 -)5)5 17 978"'4G7d 46
Construction Debris Disposal affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit _ _ is issued with the condition that the debris resulting from
dtis work shall be disposed of in a properly Licensed waste disposal facility as defined by V1GL c
l 11, S 150A.
The debris will be transported by:
y�vAM C✓�s7-P
I'L•c Jcbris will be disposed of in
' - 28 CRESCENT DRIVE '
.. ._
o,un,i
of � ttlrm, C ttssttt�juse##s kir N 2 5o J'A '09
�varb of �17Ffal FILE;
CITY ".LE
DECISION ON THE PETITION_ ENOF CALVIN.AND FRIEDA HAMSON FOR A
SPECIAL PERMIT AT�28 CRESC_ T DRIVE (R,1 )
A hearing on this petition was held May 17, 1989 with the following Board
Members present: James Fleming, Chairman; Richard Bencal , Vice Chairman: John
Nutting, Secretary and Associate Member LaBrecque. Notice of the hearing was
sent to abutters and others and notices of the hearing were properly published
in the Salem Evening News in accordance with Massachusetts General Laws Chapter
40A.
Petitioners, owners of the property, are requesting a Special Permit to allow
construction of a deck addition in this R-1 district.
The provision of the Salem Zoning Ordinance which is applicable to this request
for a Special Permit is Section V B 10, which provides as follows:
Notwithstanding anything to the contrary appearing in this Ordinance, the Board
of Appeal may, in accordance with the procedure and conditions set forth in
Section VIII F and IX D, grant Special Permits for alterations and reconstruction
of nonconforming structures, and for changes, enlargement, extension or expansion
of nonconforming lots, land, structures, and uses, provided, however, that such
change, extension, enlargement or expansion shall not be substantially more
detrimental than the existing nonconforming use to the neighborhood.
In more general terms, this Board is, when reviewing Special Permit requests,
guided by the rule that a Special Permit request may be granted upon a finding
by the Board that the grant of the Special Permit will promote the public health,
safety, convenience and welfare of the City's inhabitants.
The Board of Appeal , after careful consideration of the evidence presented, and
after viewing the plans, makes the following findings of fact:
1 . There was no opposition presented;
2. The proposed addition would allow a more fuller use of the present
deck space;
3. The proposed addition would not encroach on any setbacks.
On the basis of the above findings of fact, and on the evidence presented, the
Board of Appeal concludes as follows:
1 . The granting of the Special Permit will be in harmony with the district
and will promote the public health, safety, convenience and welfare of
the City's inhabitants.
2. The relief requested can be granted without substantial detriment and without
nullifying or substantiall derogating from the intent of the district or
the purpose of the Ordinance.
DECISION ON PETITION OF CALVIN AND FREIDA HAMSON FOR A SPECIAL PERMIT
AT 28 CRESCENT DRIVE, SALEM
page two
Therefore, the Zoning Board of Appeal voted unanimously, 4-0, to grant the
relief requested, subject to the following conditions:
1 . Petitioner meet all requirements of the Salem Fire Dept. relative
to smoke and fire safety;
2. All construction be as per the plans submitted and by legal
building permit;
3. All construction be done as per all existing city and state building codes.
GRANTED
4*10a)
Richa�cal , Vice Chairman
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of the Mass.
General Lams, Chapter 808, and shall be filed within 20 days after the date of filing
of this decision in the office of the City Clerk.
Pursuant to Mass. General Laws, Chapter 808, Section 11, the Variance or Special Permit
granted herein shall not take effect until a copy of the decision, bearing the cert-
ification of the City Clerk that 20 days have elapsed and no appeal has been filed,
or that, if such an appeal has been filed, that it has been dismissed or denied is
recorded in the South Essex Registry of Deeds and indexed under the name of the owner
of record or is recorded and noted on the owner's certificate of title.
Board of Appeal